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everett <br /> e � <br /> City of Eveiett 1 ' 7� I � 3 Z Z s Z <br /> Engineering Department U <br /> Sewer Application and Permit <br /> NO. �� OO � ✓ DATE <br /> Service Address Utility Account No. __ <br /> . . !�l": . � . <br /> Billing Address Connection Permit Fee - <br /> �• e.-.��? � - <br /> City, State, Zip Connection Fee � <br /> Owner (Mortgagor�_ ' Total Fee � "" - <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Customcr <br /> Phone_ <br /> DESCRIPTION: <br /> Lot_ ' <br /> Block_ G�� �� �_ yL� ' �LI <br /> Division or Addition '` � <br /> ��.. � i ' , <br /> `� = `� Sewer District "'' <br /> Nlor thly Sewer Service "- <br /> Remarks: - — <br /> Mumnly Sewer Constr. � _ _ <br /> , Approved By <br /> I Ciry Enqinecr <br /> Issued ey <br /> ;�.r c�.w�}- a � t� �� �k c.1.�,�•4� � o ,. , ,f� <br /> --1� —� Connection By <br /> Inspection 8y <br /> Date Inspected_ <br /> :81 <br /> SEESKETCH ATTACHED <br /> ;�. .�:�.�.r�nnr, <br />